Accessory Navicular

 Accessory Navicular?  What is that you may ask?

Google tells me that “an accessory navicular is an extra bone that is on the inner center arch of the foot. Up to 2.5 percent of individuals are born with the accessory navicular. Throughout early childhood, this condition is not noticed. However, in adolescence, when the accessory navicular begins to calcify, the bump on the inner aspect of the arch becomes noticed … Accessory navicular is a fairly uncommon condition which is rarely symptomatic”

An Accessory Navicular (AN) is something you are born with.  It is an extra piece of cartilage located in the inner side of the foot just above the arch.  As children grow this cartilage develops into bone.  For most people this AN is not a problem.  The above quote says 2.5% of the population have an AN, but various websites give different numbers anywhere from 2% to 21%, 4% being the most common.  The reality is that they don’t really know how many people actually have an AN because if your foot is not giving you pain you’re not going to be having an x-ray done to indicate it is there.  What they do know is that of those who do have an AN it is rare or uncommon for them to be symptomatic, if it is symptomatic often non-surgical treatment can help, such as custom orthotics, in a small number of cases surgical intervention is required.

So why the foot anatomy lesson?  Well ... doesn’t something like this pretty much fit with our “One Percent Family”? 🤷

Over the past 5 years Matthew has had feet pain.  He was originally diagnosed with planter fasciitis, which I knew was incorrect at the time based on where his pain was, but since orthotics seemed to take the edge off the pain we just stuck to making sure all his shoes had orthotics.  Summer of 2019 rolls around and he's hobbling pretty bad, along with having some knee issues.  Now that we have a benefits plan I figured we might as well invest in some custom orthotics to help settle this issue.  

An x-ray from the podiatrist showed us that Matthew has Accessory Naviculars.  Over the next 6 months we work with a podiatrist, custom orthotics, knee braces (is the knee pain from how he's walking, is he walking this way because of the knees or the feet?), physiotherapy for the knees and the feet, several bouts of complete rest, icing and oral and topical anti-inflammatories, and shockwave therapy.  The knee pain was likely Osgood Schlatter and between time, braces and physiotherapy this pain has mostly subsided.  Custom orthotics took a bit of the edge off of the pain in his heels for basic walking, but it returns as soon as he is more active.  Unfortunately nothing has helped the pain in the AN area, except for sitting on his butt and doing absolutely nothing, which COVID proved when all sports came to a stop and he was able to truly rest, but as soon as he got back out to do sports or a long walk the pain was back.    

The podiatrist we seen was hesitant to do surgery, feeling it was better to wait until Matthew had finished growing.  As I did some research and read what I could find about AN Syndrome, I found that the surgery was often done around age 10-12 and many adults who had the surgery had suffered with pain throughout the years and wished they had had it done at a younger age.   And so we decided to get a second opinion from someone who normally deals with children, which meant heading to Calgary to the Children's Hospital to see an Pediatric Orthopedic Surgeon.

Our first visit to Alberta's Children's Hospital (ACH) was a bit of a waste of time.  I'm not sure why, but we didn't actually see a surgeon, I think the guy we saw was just a pediatrician (from what I can tell from google).  Maybe it's a bit of a triage process, but what he suggested was nothing we hadn't tried already.  The only difference was that he wanted Matthew to talk Aleve consistently for one month and wear his orthotics/shoes at all times, except when sleeping 😆  After one month we called to say it had made no difference and we were placed on the list to see a surgeon ... except by this time COVID had hit and it wasn't until the end of September that we seen the Orthopedic Surgeon.

We are able to see the Orthopedic Surgeon on September 29 and he presented Matthew with three options: 

#1 - Do nothing - it may go away in a year, or 5 years, or 20.   With this option is the choice to live with the pain or adjust his lifestyle to reduce the pain.
#2 - Have surgery done to remove the AN and reattach the tendons properly.  Do one foot, wait 6 months until recovered and then do the other foot. 

#3 - Have surgery done on both feet at the same time.

Matthew had no trouble ruling out #1.  He wasn't for surgery during the first months of constant pain, but by this point he just wants to be done with the pain.  The pain is pretty much constant and increases as soon as he does almost any activity (except biking, which he loves to do and is very thankful for).  During the winter when he played both basketball and hockey there were days where he pretty much crawled once he got home because it was so painful to walk.  Ice and pain medicines did nothing to reduce the pain.  But he loves his sports and so he would get up and go out and do them again the next day.  At first I would often think it couldn't be that bad if he would go back and do more sports, but eventually you could see that it was just the stubbornness of not giving in and trying to enjoy himself without having to sit on the sidelines all the time.  And some days no matter how hard he tried to keep going and ignore the pain he would still be hobbling.  So #1 was not an option in his mind.

The decision was between #2 and #3.  He knew he wanted #3 but we had to help him realize some of the logistics of this so we knew he had made a decision knowing what he was getting into.  For a period he felt guilting for wanting #3 since it would be more work for us, but we also helped him to realize that we were okay with that, and in the end doing it once with more work would probably be less then doing it twice and all the extra driving back and forth to Calgary and physio etc.  And so the decision was made to move forward with option #3.

We had thought this would mean a surgery wait of about a year, giving us many more months to be confident in this decision and that he wasn't outgrowing the pain.  But we were surprised to find out that they expected to be able to do the surgery at the end of November/beginning of December.  And even more surprised a few weeks later when we actually got a surgery date of November 9th. 

As far as surgery goes, the surgery itself is not that complicated.  They will make a small incision by the navicular bone and take out the extra part of the bone.  They will then reattach the tendons to the navicular bone.  It is assumed that this is why he has so much pain.  The tendons are messed up and being interfered with by the bone and so this will have to be reconstructed based on what they find.  Depending on what they find they will either attach the tendons with sutures or it will be screwed into place.

It is the recover period that is the difficult part.  In order for the tendon to properly reattach he will have to be non-weightbearing for 6 weeks.  This means six weeks of no use of his feet.  And this is why the decision to do both feet comes with a lot of extra work.  He will be wheelchair bound for six weeks, will have to learn how to transfer himself from bed to chair to toilet, etc without using his feet.  We of course can help, but with time hopefully he can become somewhat independent.  Getting him in and out of the house means carrying him up and down nine steps, but once in the house everything he needs is on the main floor.  We moved him into the spare bedroom, so he is on the main floor.  Elevating his legs will be really important for the first days, so we are expecting he will be in bed with his feet up for the first 5-7 days.  After that we will see how he's doing and how independent he is able to be and then figure out the whole return to school process. 

So here we are the night day before surgery.  It was a busy couple weeks before hand getting in some last minute appointments and prep before surgery as well as the challenge of getting his medical equipment for post-surgery organized - you would think that there would just be a simple system for out-of-town children seeing as it's a Children's Hospital that serves more then just Calgary, but alas, nothing in the medical system ever seems simple or straightforward.  Regardless, by Friday morning we finally had all the correct equipment.  And by Friday evening we were on the road headed to Calgary due to a blizzard that was suppose to hit southern Alberta.  We did not want to get stuck in Coaldale unable to make it to Calgary, so we headed up before the storm came. The storm arrived later then expected (we could have waited until Saturday morning to leave), but it did arrive and we are thankful to be in Calgary, at the Ronald MacDonald, right across the road from the hospital.  The weather will not prevent us from getting to his surgery, now it's just a little over twelve more hours of him staying healthy with no sniffles before we arrive at the hospital at 6:45 am

September 2020

I had to look for a while to find a picture where he wasn't wearing a hat.  They are pretty much a permanent fixture on his head.  But prior to surgery I wanted his hair short so I did not have to concern myself with keeping his greasy hair clean (that's enough of a battle when he has two feet and can shower himself 😨).  So just so you all know 😁... he HATES his new haircut!!!  He didn't think I meant "that short" when I said short.  My preference would have been a buzz cut, then he could just sponge bath that part of his body too.  For now he gets short fuzzy hair, with no product in it, so it doesn't get greasy as fast.

Haircut done!  Ready for a Swim!
Friday night we stayed in a hotel and on Saturday afternoon we got a call that the Ronald MacDonald House had a room available for us, so we moved there Saturday afternoon - but not before Rob and Matthew got a swim in.

Oh ... and his sisters dared him to get pink and purple casts.  I don't think it's worth the $10's they'll give him, but we'll see what he decides 😲  I'm sure if someone offered him more money he'd have an easier time deciding 😆 or maybe he just wants those colours because he knows how much his mom and dad don't want them 🤷

It is our heartfelt prayer that all goes well with surgery tomorrow, that the Lord may bless the surgeon's hand as he does his work.  In a world where less invasive medical procedures are a daily event we often just assume that all will go as planned, but we know that all will go as GOD plans and so we lay this before Him knowing that He will be watching over Matthew.  We pray that the outcome may be relief of pain, but we also know that whatever the outcome may be God will strengthen and carry us, just as He has done in the past.

This is the confidence we have in approaching God: that if we ask anything according to his will, he hears us. And if we know that he hears us—whatever we ask—we know that we have what we asked of him.  ~1 John 5: 14,15